Provide complete identification and documentation details for the affected shipping container. All identification numbers must be verified against physical markings before entry.
Container Number
ISO Container Code
Container Size and Type
20ft Standard Dry
40ft Standard Dry
20ft Refrigerated
40ft Refrigerated
20ft Tank
40ft Tank
20ft Open Top
40ft Open Top
Other Specialized
Vessel Name
Voyage Number
Port of Origin
Destination Port
Estimated Time of Arrival (ETA)
Estimated Time of Departure (ETD)
Container Seal Numbers
Master Bill of Lading Number
House Bill of Lading Numbers
General Cargo Description as per Manifest
Shipper Name and Contact Details
Consignee Name and Contact Details
Container Position on Vessel (Bay/Row/Tier)
Terminal Location (Block/Row/Slot)
Photograph of Container ID Plate and CSC Safety Approval Plate
Photograph of Seal Condition and Door Gaskets
Conduct systematic assessment of the leak or breach. Determine the nature, severity, and immediate hazards. All observations must be documented with photographs and quantitative measurements where possible.
Was a leak or breach detected during inspection?
Does the container display hazardous materials placards or markings?
UN Number(s) of Leaked Substance
Proper Shipping Name of Substance
Primary Hazard Class
Class 1 - Explosives
Class 2 - Gases
Class 3 - Flammable Liquids
Class 4 - Flammable Solids
Class 5 - Oxidizing Substances
Class 6 - Toxic and Infectious Substances
Class 7 - Radioactive Material
Class 8 - Corrosive Substances
Class 9 - Miscellaneous
Not Applicable
Packing Group (when applicable)
I - Great Danger
II - Medium Danger
III - Minor Danger
Not Applicable
Estimated Quantity of Material Released (in liters or kilograms)
Physical State of Released Material
Liquid
Gas/Vapor
Solid
Mixed/Multiple States
Is an odor detected?
Visual Indicators Observed (select all that apply)
Staining on container exterior
Corrosion or rust-colored residue
Visible vapor cloud or mist
Liquid pooling beneath container
Frost or ice formation
Discoloration of container shell
Dripping from valves or fittings
No visible indicators
Probable Source of Leak
Door seal or gasket failure
Valve packing or flange
Tank wall puncture or crack
Floor damage or corrosion
Pressure relief device activation
Hatch seal failure
Unknown or multiple sources
Estimated Leak Rate (1 = Droplets, 5 = Continuous Stream/Heavy Flow)
Container Structural Damage Severity
Pressure Gauge Reading (if applicable, in kPa or bar)
Temperature Reading (if applicable, in Celsius)
Photograph of Leak Source and Affected Area
Additional Photographs from Multiple Angles
Upload Video Evidence of Leak or Vapor Release
Detailed Description of Physical Breach or Damage
Types of Structural Damage Observed
Dent or deformation
Puncture hole
Crack or fracture
Door misalignment
Hinge failure
Corner casting damage
Floor breach
Wall panel separation
Breach Dimensions (Length x Width x Depth)
Overall Container Integrity Assessment (1 = Very Unstable, 5 = Structurally Sound)
Document all immediate response actions taken to secure the area and prevent escalation. Time-sensitive actions must be recorded with precise timestamps. All containment measures require photographic evidence.
Exact Time of Discovery
Inspector Full Name
Inspector ID Number
Weather Conditions at Time of Discovery
Clear and calm
Light rain
Heavy rain
High winds
Fog or low visibility
Extreme heat
Extreme cold
Thunderstorm
Is the container located within 50 meters of populated terminal areas (offices, break rooms, active loading zones)?
Immediate Actions Taken Upon Discovery (select all that apply)
Evacuated immediate area
Established safety perimeter
Shut down adjacent equipment
Deployed absorbent materials
Activated emergency ventilation
Notified terminal control center
Contacted emergency response team
Posted safety observers
Safety Perimeter Distance Established (in meters)
Number of Personnel Evacuated from Area
Equipment Shutdown Log
Equipment ID | Equipment Description | Shutdown Time | Confirmed Isolated | |
|---|---|---|---|---|
Ventilation System Status
Activated to disperse vapors
Shut down to contain vapors
Not applicable
No action taken
Was a decontamination corridor established?
Wind Direction Relative to Container
North
Northeast
East
Southeast
South
Southwest
West
Northwest
Variable/Calm
Wind Speed (in knots or m/s)
Containment Materials Deployed
Absorbent pads and booms
Sandbags or earth berms
Plastic sheeting or tarps
Overpack drums
Sealant putty or tape
Diversion channels
Neutralizing agents
None deployed
Estimated Volume Successfully Contained (in liters)
Estimated Volume Released to Environment (in liters)
Were storm drains or water bodies protected?
Photograph of Isolation Perimeter and Containment Measures
Photograph of Emergency Equipment Deployment
Evaluate environmental impact and coordinate specialized hazardous materials response. Document all external agency notifications and resource deployments. Assess risks to surrounding assets and natural resources.
Has soil contamination been detected in the immediate area?
Has the released material reached surface water or drainage systems?
Has air quality monitoring been initiated?
Have there been any observed impacts to wildlife or vegetation?
Has a certified Hazmat Response Team been formally dispatched?
Hazmat Response Level Activated
Level 1 - Minor Incident
Level 2 - Moderate Incident
Level 3 - Major Incident
Level 4 - Catastrophic Incident
Specialized Cleanup Equipment Requested
Vacuum trucks
Neutralizing agents
Overpack salvage drums
Decontamination trailers
Air monitoring stations
Personnel protective equipment (PPE)
Cranes or lifting gear
Specialized cutting/welding equipment
Have decontamination procedures been initiated for personnel and equipment?
Have waste disposal containers been prepared and labeled?
Has secondary containment been deployed around the container?
Environmental Monitoring Equipment Deployed
Photoionization detectors (PID)
Multi-gas meters
Chemical-specific sensors
Soil sampling kits
Water quality meters
Radiation detectors
Meteorological station
None deployed
Have sampling points been established for environmental testing?
Are adjacent containers at risk of contamination or damage?
Emergency Notification Log
Party Notified | Time of Notification | Contact Person/Title | Acknowledgment Received | |
|---|---|---|---|---|
Terminal Management | 2:35 PM | Operations Manager | ||
Port Authority | 2:40 PM | Duty Officer | ||
Marine Safety Officer | 2:42 PM | MSO On-Call | ||
Environmental Response | 2:45 PM | Incident Coordinator | ||
Estimated Cleanup Duration (hours)
Estimated Initial Cleanup Cost
Photograph of Hazmat Team Arrival and Equipment Setup
Final authorization and incident closure documentation. All clearance decisions must be made by designated authority figures. Complete documentation ensures regulatory compliance and operational safety for terminal resumption.
Port Captain Notification Time
Marine Safety Officer Notification Time
Designated On-Scene Commander Name and Title
Incident Reference Number
Has the safety perimeter been cleared for restricted access?
Has re-entry authorization been granted for essential personnel?
Is container movement authorized to a designated safe area?
Has environmental clearance been granted by regulatory authorities?
Documentation Completeness Verification
Incomplete | Partial | Complete | Verified | |
|---|---|---|---|---|
Container identification records | ||||
Hazard classification details | ||||
Containment action logs | ||||
Environmental assessment | ||||
Notification timestamps | ||||
Photographic evidence | ||||
Chain of custody forms |
Final Incident Assessment Summary
Port Captain or Designated Terminal Authority Signature
Marine Safety Officer or Environmental Authority Signature
Official Clearance Date and Time
Next Steps and Follow-Up Actions Required
Lessons Learned and Recommendations for Prevention
Incident Closure Status
Open - Under Investigation
Open - Cleanup in Progress
Open - Awaiting Lab Results
Closed - Resolved
Closed - Referred to Authorities